Ligator



Sept. 16, 1952 D. J. CALICCHIO 2,610,631

LIGATOR Filed Nov. 2, 1949 2 SHEETS --SHEET 1 I71 116711237" Ba aid J. Calicchio a 'l'lo T776118 P 16, 1952 v D. J. cALlccHlo 2,610,631

LIGATOR Filed Nov. 2, 1949 2 SHEETSSHEET 2 [77 11377122?" David J. 6aZz'cch'i by w a Z??? 7 776 ya Patented Sept. 16, 1952 UNITED STATES PATENT. OFFICE" i 2,610,631 a i I LIGATOR V I David J. Calicchio, Boston, Mass. Application November 2, 1949, Serial No..125,0'i9

. l The'pres'en't 'inventionrelates to surgical instruments, and more particularly to ligators, especially ligators for tying deep ligatures.

Though there is 'no difficulty involved in tying ordinary knots under ordinary conditions, difficulties do arise,v whenlitbecomes necessary to make a tie inisome deep region of thezbody, as frequently occurs in surgery of the. abdomen, tonsillectom'ies, and the like; In order that the surgeon may have a clear and free field inwhich to work, he must tie 01f all the .blood vessels in that field, but it taxes the skill oflthe' "ablest surgeons to do this in cases where the anatomical parts are almost inaccessible and the fingers are obliged to work almost blindly. 1..

It ,has accordingly been proposed to provide instruments to aid in'this work.. Unfortunately, however, these prior proposals have been so impracticable that, so far as known, they have never goneintousef V w v One such proposal, for.examp1e, .has involved passi thr u an op ning at the forward end of a basemember a ligature one end of which is providedwithl a slipknotfor encircling the severediblood vessel to be tied whileheldclamped by a hemostat, and tying the other end of the ligature to a member that is slidably mounted-- on the base. member. The proposal was to tighten the knot by sliding the slidable member along the base member. The forward end of the proposed base member, however, was of so small dimensions as to involve danger of the surgeon, during the manipulation of the instrument, puncturing the body tissues. The proposed instrument was so short, moreover, that the knot could not be tightened merely by sliding the slidable member on thebase member to the limit of its slidable movement. It became necessary, therefore, to discard the instrument at a time when the knot was still not yet tight, and to complete the work "of tying the knot without its aid. The proposed instrument was of such nature, furthermore, that the free end of the slip knot would frequently get in the way of the field of view of the operation, and this would necessitate's'topping the work in order to remove it out of the way. There were other disadvantages also. An object of the, present invention, therefore, is to provide a new and improved ligator that shall be entirely free of all these disadvantages. Other and further objects will be explained hereinafter and will bev particularly pointed out in theappended claims, 1 I I The invention will now be more fully explained Claims. (01. '12 8 326):

v2 r I in connection with the accompanying drawings,

in'which: V

Fig. 1 is a plan of aligator embodyingthe present invention, with a ligature applied thereto, ready for tying a bleeding point; Fig. 2 is aside elevation of the same; Figs. 3 and 4 are sections taken upon the finest-+3 and 4.4, re spectively, of Fig. 2, looking in the direction of the arrows; Fig. 5 is a similar section taken upon the line 5-5 of Fig.1; looking inthe direction of the arrows; Fig. 6 is a perspective illustrating the operation of the ligator of the present invention; and Fig. '7 is a fragmentary perspective, upon a larger scale, of the lower portion of the ligato rv and adjacently. disposed, parts illustrated in Fig. 6. '5 v The ligator of the present invention comprises a base member I upon which is slidably mounted amember l0. a, V

The base member I is provided with a rearwardly disposed thumb rest 6, shown in the form ofxa ring, and a' forwardly disposed portions capped by a terminal portion, 4 provided with a terminal collar 5. The portion 4 is fixed by means of a 513811119 in a recess 20 provided at the, extreme, end of the forwardly disposedportion 3. The terminal collar 5-is of substantial area, in order to provide a blunt portion which, because of the bluntness, may engage the tissues of the patient without danger of perforating them. At diametrically opposit points, the collar 5 'is provided with the two; openings 2|.

Through onof the openings, 2!, which may be termed a first opening, may be threaded a ligae ture the forward end of which is provided with a slip or 'otherloose knot 23, beyond which extends loosely a ligature loop 24.. The other opening 2|, which may 'be'termed'a secon opening, is adapted to receive the free end '22 of'the slip knot 23. Thefree end 22 of the slip knot 23 is thus forced away, so as not to obstruct the surgeons view of the field of the operation, and so as not to interfere with the manipulation of the instrument.

The base member I is shown cylindrical, and mounted in a correspondinglycylindricalbore of the slidable member In. In order that the ligature may become subjected to straight-line tension during the tightening of the slip knot 23, it is desirable that the slidable member ID be nonrotatable during its slidable movement. In order to prevent such rotation of the slidable member [0 during its slidable movement upon the base member I the base member I isshown flattened a correspondingly flattened surface of a filler member 32 that is held in place in the cylindrical bore of the slidable member ID in any desired manner, as by means of a rivet 3i.

The slidable member ID is provided with a finger rest, shown constituted of two finger rings 9. In response to pressure exerted by the thumb on the thumb rest 6 and by any two fingers upon the finger rings 9, the member It] will be caused to sliderearwardlyalong the base: member'l toward the thumb rest 6. Since the slidable member l cannot rotate during its slidable movement upon the base member I, it is desirable, in order to provide for relative twisting move ment of the thumb and the fingers, to render the thumb rest 6 freely rotatable. According tothe.

illustrated embodiment of the invention, ,this ree sult is attained by freely mounting the rear' end of the base member I rotatably in a longitudinally disposed cylindrical socket of a forward extension 1 of the thumb .restB. A rivet 8 pro-. iects through a side wall of the extension [into a peripherally disposed groove provided'atithe rear end of. the base member I; 'The rivetflfl, though preventing detachment'of the parts, permits of the thumb restfi rotating freely about .the axis of the cylinder of the .base. member'l.

The ligature loop 24 isoriginally made-large enoughto encircle a hemostat.35, shown clamped to a bleedingpointte. After the hemostat has been carried entirely through the loop 24, the loop24 is contracted until it engages theiclamped bloodvessel 38. This may be effectedloy-slidably looping. an intermediately. disposed portion 25 of the ligature next adjacentlto theslipjknot 23 around a pulley-like-shaped' portion 121 ofja projection ll of the slidablemember. [0,.then carrying the ligature forwardiagainwas. shown at 21, and applying tension. The slidablemember IE] is thus forced on the base member I, .into contact with a stop member. l.3;,fl..as. illustrated in Figs. 1 and 2. Theligature 25-.isthen wound severaltimes around a. projecting post I6 dis posed intermediately ofthe base member. as shown at 28, after which its freerear end 2'9. is fastened in place in an intermediately disposed slit l5 provided in aportion ldofthe projecting post [6.

The surgeon now' introduces his'thumb into thumb ring 6 and two fingers-into the-fingerrings 9 to exert pressurebetweenhis. thumb andhis fingers. This results in. drawing the slidable member Iil rearward, out ofcontactwiththe stop member l3, from therpositionof'Figs. .1 and12 toward and beyond the position illustratedjin Fig. 6. The consequent tension introduced inthe ligature, as thecollar 5' presses-againstthetslip knot 23, tautens the ligatureloopiZE-ltoeifct the tightening of the slip knot.23. The hemostat 35 and the ligature may now b'e.removed,' after which the ligature v.andfits free end .22 may. be severed.

The projection His shown hired to theslidable member Iii by providing it with aprojecting tongue .33 that is securedin a correspondingly shaped recess .33 .of the-slidablemember 10. The projection l'B is shown. similarly, securedfiniplace by-p'rovidingitwith a post ITandsecuringit'in a correspondingly shapedi recess 18" of the base member I;

By reason of this construction, the length .of the ligature" that may'bei'taken up" during the above-described tightening-of, the loop '24 is double the distance of slidable; travel of'the ligature were fastened to the projection H, instead of to the post it, this length, of course, would be the same as the distance of slidable travel of the member it. Under such circumstances, the slidable member [0 might travel into Contact with the extension I of the thumb rest 6 without sufiiciently tightening the slip knot 23. The present invention overcomes this danger.

It is possible, of course, to provide for tripling, or'even quadrupling, the length ofthe' ligature taken up" during 'the slidable movement of the slidable member W by looping the ligature, not only around the projection H, but also around the post it, as well. The free rear end 29 of the ligature would then be secured to the slidable member lfl instead of to the post It of the base memberl. It is found, in practice, however,

that the doubled length of ligature obtained by thedescribed construction is quite suflicient for ordinary purposes.

The ligature of the present invention is particularly adapted for'tying bleeding pointsi36' in deep anatomioalregions, as indicated by thercross Sectional configuration .31, where it is difiicult' for the surgeon to introduce'his fingers,,andiflwhere it is difficult for him to: work freely;

Modifications will occur to persons skilledin the art and all such are considered to fall within the spirit and scope of theinvention as'defined in the appended claims.

What is claimed is: j

1. A ligator comprising a b'asetprovidediwith a rearwardly disposed thumb rest .and a forwardly disposed single-ended terminal portion provided with a terminal collarhaving. a vfirst opening through which may be loosely passed .ailigature the'iforward end'of whichgis provided with .aslip knot and a'secon'd opening forgreceiving the free end of the slipknot, and a member provided with a finger rest and meansfor fasteningithe rear end of the ligature, the member being rearwardly slidable upon the base in response to pressure exerted by the thumb on the thumb rest and'bya finger upon the finger rest :to: draw the ligature through the first opening'inorder thatthe .slip knot may engage the terminalportion to become tightened, and-the terminal collarbeingof substantial area to render the ligator bluntatjits extreme forward end to minimize danger-of the said extreme forw-ard'end perforating 'tissuethat it may engage.

2. A ligator comprising abase' proyided' with a rearwardly disposed thumb rest and a forwardly disposed single-ended terminal portion provided with a terminal collar having a first opening through which-may be loosel-y'passeda ligature the forward end of e which is provided with a slip knotanda second opening forreceiving thefree endof the slipknot, and -a member-provided with axfi'nger'rest and means for slidably looping a'n intermediately' disposed portion of i the ligature as well as means for fastening. the rear" end: of the "ligature, the :member being-rearwardly slidable upon thebase in response to pressureexerted by the thumb on the-thumb'rest and bye finger upon the finger rest to draw-thaligature through the first opening in order that -the'slip -knot may engage the terminal portionto become tightened, and the. terminal collar being .of substantial area to render the ligator blunt .atits extreme forward end tominmize danger of the said extremeforward end perforating tissue that it mayengage.

3. A ligator comprising ,a base providediwith a rearwardly disposed thumb rest, and .a. forwardly disposed single-ended terminal ,portion .having a first opening through which may be loosely passed a ligature the forwardend of which is provided with a slip knot and a second opening for receiving the free end of the slip knot, a member provided witha finger rest and means for slidably looping an intermediately disposed portion of the ligature as well as means for fastening the rear end of the ligature, the member being rearwardly slidable upon the base in response to pressure exerted by the thumb on the thumb rest and by a finger upon the finger rest to draw the ligature through thefirst opening in order that the slip knot may engage the terminal portion to become tightened, and the terminal portion being of substantial area to render it blunt at its extreme end to minimize danger of its perforating tissue that it may en- 4. A ligator comprising a base provided with a rearwardly disposed thumb rest, intermediately disposed means for fastening the rear end of the ligature and a forwardly disposed single-ended terminal portion having a first opening through which may be loosely passed a ligature the forward end of which is provided with a slip knot and a second opening for receiving the free end of the slip knot, a member non-rotatably slidable rest to draw the ligature through the first opening in order that the slip knot may engage the terminal'portion to become tightened, and the terminal'portion being blunt to minimize danger of its perforating tissue that it may engage.

5. A ligator comprising a base provided with a rearwardly disposed portion and a forwardly disposed single-ended terminal portion provided with a terminal collar having a first opening through which may be loosely passed a ligature the forward end of which is provided with a slip knot and a second opening for receiving the free end of the slip knot, and a member provided with means for fastening the rear end of the liga-' ture, the member being rearwardly slidable upon the base to draw the ligature through the first opening in order that the slip knot may engage the terminal portion to become tightened, the terminal collar being of substantial area to render the ligator blunt at its extreme forward end to minimize danger of the said extreme forwith respect to the base provided with a finger rest and means for slidably looping an intermediate portion of the ligature as well as means for fastening the rear end of the ligature, the member being rearwardly slidable upon the base in response to pressure exerted by the thumb on the thumb rest and by a fingerupon the finger ward end perforating tissue that it may engage.

7 DAVID J. CALICCHIO.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 614,760 Richter Nov. 22; 1898 1,855,546 File Apr. 26, 1932 2,131,321 Hart Sept. 27, 1938 2,258,287 Grieshaber Oct. 7, 1941 

